| NPI | 1114768280 |
|---|---|
| Other Name | PHOENIX JETT-DIAS |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 174400000X Specialist | |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-08-28 |